Anal Papanicolaou Smear in Women with Abnormal Cytology: a Thai Hospital Experience

Abstract

Background: Anal intraepithelial lesions (AIL) are likely to represent a precursor for anal cancer. Women infected with human immunodeficiency virus (HIV) may be at higher risk of anal cancer but a screening program for AIL still is not routinely recommended. We here studied the relationship of dysplastic cells from cervical and anal cytology in HIV-infected women. Materials and Methods: This prospective study was conducted in Prapokklao Hospital, Thailand during 2013-2014. Five hundred and ninety nine HIV-infected women were recruited. Participants who had cytological reports of equally or over "abnormal squamous/glandular cells of undetermined significance" (ASC-US) were classified as abnormal cervical or anal cytology. Descriptive statistics and logistic regression analysis were used to evaluate correlations between groups. Results: HIV-infected women with abnormal cervical cytology had 3.8 times more risk (adjusted odd ratio 3.846, 95% confidence interval 1.247-11.862, p-value. 019) for abnormal anal cytology. The major problem of the anal Pap test in this study was the inadequacy of the collected specimens for evaluation (34.4%, 206/599). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of cervical and anal Pap tests were 93.9/12.0, 87.3/96.9, 39.7/21.4, 99.4/94.1 and 88.1/91.4 percent, respectively. Conclusions: Abnormal cervical cytology in HIV-infected women indicates elevated risk for abnormal anal cytology. The sensitivity of the anal Pap test for detection of AIL 2/3 in HIV-infected women was quite low while specificity was excellent. Inadequacy of specimen collection for evaluation was a major limitation. Improvement of sample collection is recommended for future investigations.

Results of the Women's Self-Performed Anal Pap Trial in Human Immunodeficiency Virus–Infected Women

“…Although 34% of specimens were inadequate for evaluation in a previous study of anal Pap tests in HIV-infected women, 8 adequacy in our study was similar to that reported in a group of mostly HIV-negative men who have sex with men. In addition, fewer inadequate specimens were noted with provider-performed anal specimen collection.…”

Application of Bethesda terminology to categorize buccal epithelial smears among petroleum station workers in Taif city, KSA

“…Moreover, this method is relatively easy in interpretation. When concerned about cervical cancer screening, Pap test is widely accepted as an effective screening tool for cervical precancerous lesions and cancer [15]. However, there is still no definite grading recommendation offered for oral cytological changes which may progress to cancer.…”

“…This may be attributed to lack of interest in oral cytology or the high rate of false results caused by inadequate sampling procedures, low cellularity or variation in technical quality [14]. In settlement with our approach, a previous study adapted Papanicolaou smears to categorize anal intraepithelial lesions using Bethesda System Terminology [15]. In this study, we have demonstrated that about 38.6% of petrol station workers exhibit buccal cytological changes ranging from ASC-US to HSIL, which are approved to be precancerous changes in accordance with the Bethesda System Terminology applied for cervical epithelial lesions.…”

“…Evaluation criteria for buccal cytology used in this study followed 2001 Bethesda System Terminology [15], [17].…”

“…Samples were smeared rapidly and gently on the glass slides to avoid drying the cells, which may cause marked artifacts that can preclude an adequate cytological evaluation. Smears were rapidly immersed in 95% ethanol for 15 minutes which is the method of choice [15]. In the laboratory, the Papanicolaou stained smears were prepared as described by Bancroft [16].…”